Patient-specific humeral guide designs

ABSTRACT

A humeral cut guide member for resectioning or resurfacing a humeral head, including a bone-engagement member including a first patient-specific bone-engagement surface that is complementary and made to substantially mate and nest in only one position on a specific patient&#39;s humeral head; a registration member connected to the bone-engagement member including a second patient-specific bone engagement surface that is sized and made to substantially mate and nest in only one position with the specific patient&#39;s bicipital groove; and a cut guide plate connected to the bone-engagement member and defining an elongated slot.

FIELD

The present disclosure relates to humeral cut guide members.

BACKGROUND

This section provides background information related to the presentdisclosure which is not necessarily prior art.

During shoulder arthroplasty, the humeral bone may require resurfacingor resecting for receipt of a shoulder implant. Prior to surgery, it iscommon for the surgeon to take various images via X-ray, CT, ultrasound,MRI, or PET of the surgical area including the humeral bone. Based onthese images, the surgeon can determine the best course of action forresurfacing or resecting the humeral bone, as well as determine whetherthe primary procedure for shoulder repair is an anatomical or reversearthroplasty. During the surgery, however, it is not uncommon for thesurgeon to determine that the preselected courses of action are notsuitable for the patient. If the course of action changes duringsurgery, new instruments may be required to properly complete theresurfacing or resecting of the humeral bone before completing thearthroplasty procedure.

SUMMARY

This section provides a general summary of the disclosure, and is not acomprehensive disclosure of its full scope or all of its features.

The present disclosure provides a humeral cut guide member forresurfacing a humeral head. The humeral cut guide member includes abone-engagement member including a first patient-specificbone-engagement surface that is complementary and made to substantiallymate and nest in only one position on a specific patient's humeral head,and a registration member connected to the bone-engagement memberincluding a second patient-specific bone engagement surface that issized and made to substantially mate and nest in only one position withthe specific patient's bicipital groove. The humeral cut guide memberalso includes a cut guide plate connected to the bone-engagement memberand defining an elongated slot.

The present disclosure also provides a humeral cut guide member forresectioning or resurfacing a humeral head including a bone-engagementmember including a first patient-specific bone-engagement surface thatis complementary and made to substantially mate and nest in only oneposition on a specific patient's humeral head, and a registration memberconnected to the bone-engagement member including a secondpatient-specific bone engagement surface that is sized and made tosubstantially mate and nest in only one position with the specificpatient's bicipital groove. The humeral cut guide member also includes acut guide plate connected to the bone-engagement member and defining anelongated slot, wherein the cut guide plate is connected to thebone-engagement member by a tube-shaped member extending outward fromthe bone-engagement member, and the cut guide plate includes aconnection portion for receipt of the tube-shaped member such that aposition of the cut guide plate relative to the specific patient'shumeral head is selectively adjustable along the tube-shaped member.

The present disclosure also provides a method of resectioning orresurfacing a humeral head using a humeral cut guide member including abone-engagement member that includes a first patient-specificbone-engagement surface that is complementary and made to substantiallymate and nest in only one position on a specific patient's humeral head,and including a cut guide plate connected to the bone-engagement member.The method includes affixing the humeral cut guide member to the onlyone position of the specific patient's humeral head; and selectivelyadjusting a position of the cut guide plate relative to the specificpatient's humeral head by moving the cut guide plate along a tube-shapedmember that extends from the bone-engagement member.

Further areas of applicability will become apparent from the descriptionprovided herein. The description and specific examples in this summaryare intended for purposes of illustration only and are not intended tolimit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustrative purposes only ofselected embodiments and not all possible implementations, and are notintended to limit the scope of the present disclosure.

FIG. 1 is an exploded view of a prior art implant for reverse shoulderarthroplasty;

FIG. 2 is an environmental view of the prior art implant of FIG. 1 ;

FIG. 3 is a perspective environmental view of a humeral cut guide memberaccording to a first embodiment of the present disclosure;

FIG. 4 is another perspective environmental view of the humeral cutguide member according to the first embodiment of the presentdisclosure;

FIG. 5 is another perspective environmental view of the humeral cutguide member according to the first embodiment of the presentdisclosure;

FIG. 6 is a perspective environmental view of a humeral cut guide memberaccording to a second embodiment of the present disclosure;

FIG. 7 is another perspective environmental view of the humeral cutguide member according to the second embodiment of the presentdisclosure;

FIG. 8 is another perspective environmental view of the humeral cutguide member according to the second embodiment of the presentdisclosure;

FIG. 9 is a perspective environmental view of a humeral cut guide memberaccording to a third embodiment of the present disclosure;

FIG. 10 is another perspective environmental view of the humeral cutguide member according to the third embodiment of the presentdisclosure;

FIG. 11 is a perspective environmental view of a humeral cut guidemember according to a fourth embodiment of the present disclosure;

FIG. 12 is another perspective environmental view of the humeral cutguide member according to the fourth embodiment of the presentdisclosure;

FIG. 13 is another perspective environmental view of a modified humeralcut guide member according to the fourth embodiment of the presentdisclosure;

FIG. 14 is a perspective environmental view of a humeral cut guidemember according to a fifth embodiment of the present disclosure;

FIG. 15 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 16 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 17 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 18 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure;

FIG. 19 is another perspective environmental view of the humeral cutguide member according to the fifth embodiment of the presentdisclosure; and

FIG. 20 is a perspective view of a modified humeral cut guide memberaccording to the fifth embodiment of the present disclosure.

Corresponding reference numerals indicate corresponding parts throughoutthe several views of the drawings.

DETAILED DESCRIPTION

Example embodiments will now be described more fully with reference tothe accompanying drawings.

The present disclosure generally provide patient-specific surgicalinstruments that include, for example, alignment guides, drill guides,and other tools for use in shoulder joint replacement, shoulderresurfacing procedures and other procedures related to the shoulderjoint or the various bones of the shoulder joint, including the humeralhead. The present disclosure can be applied to anatomic shoulderreplacement and reverse shoulder replacement. The patient-specificinstruments can be used either with conventional implant components orwith patient-specific implant components and/or bone grafts that areprepared using computer-assisted image methods according to the presentdisclosure. Computer modeling for obtaining three-dimensional images ofthe patient's anatomy using medical scans of the patient's anatomy (suchas MRI, CT, ultrasound, X-rays, PET, etc.), the patient-specificprosthesis components and the patient-specific guides, templates andother instruments, can be prepared using various commercially availableCAD programs and/or software available, for example, by Object ResearchSystems or ORS, Montreal, Canada.

The patient-specific instruments and any associated patient-specificimplants and bone grafts can be generally designed and manufacturedbased on computer modeling of the patient's 3-D anatomic image generatedfrom medical image scans including, for example, X-rays, MRI, CT, PET,ultrasound or other medical scans. The patient-specific instruments canhave a three-dimensional engagement surface that is complementary andmade to substantially mate and match in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface with or without associated soft tissues,which is reconstructed as a 3-D image via the aforementioned CAD orsoftware. Very small irregularities need not be incorporated in thethree-dimensional engagement surface. The patient-specific instrumentscan include custom-made guiding formations, such as, for example,guiding bores or cannulated guiding posts or cannulated guidingextensions or receptacles that can be used for supporting or guidingother instruments, such as drill guides, reamers, cutters, cuttingguides and cutting blocks or for inserting guiding pins, K-wire, orother fasteners according to a surgeon-approved pre-operative plan.

In various embodiments, the patient-specific instruments of the presentdisclosure can also include one or more patient-specific guide membersfor receiving and guiding a tool, such as a drill or saw atcorresponding patient-specific insertion points and orientationsrelative to a selected anatomic or reverse axis for the specificpatient. The patient-specific instruments can include guiding ororientation formations and features for guiding the implantation ofpatient-specific or off-the-shelf implants associated with the surgicalprocedure. The geometry, shape and orientation of the various featuresof the patient-specific instruments, as well as various patient-specificimplants and bone grafts, if used, can be determined during thepre-operative planning stage of the procedure in connection with thecomputer-assisted modeling of the patient's anatomy. During thepre-operative planning stage, patient-specific instruments, custom,semi-custom or non-custom implants and other non-custom tools, can beselected and the patient-specific components can be manufactured for aspecific-patient with input from a surgeon or other professionalassociated with the surgical procedure.

In the following discussion, the terms “patient-specific”, “custom-made”or “customized” are defined to apply to components, including tools,implants, portions or combinations thereof, which include certaingeometric features, including surfaces, curves, or other lines, andwhich are made to closely conform substantially as mirror-images ornegatives or complementary surfaces of corresponding geometric featuresor anatomic landmarks of a patient's anatomy obtained or gathered duringa pre-operative planning stage based on 3-D computer images of thecorresponding anatomy reconstructed from image scans of the patient bycomputer imaging methods. Further, patient-specific guiding features,such as, guiding apertures, guiding slots, guiding members or otherholes or openings that are included in alignment guides, drill guides,cutting guides, rasps or other instruments or in implants are defined asfeatures that are made to have positions, orientations, dimensions,shapes and/or define cutting planes and axes specific to the particularpatient's anatomy including various anatomic or mechanical axes based onthe computer-assisted pre-operative plan associated with the patient.

The patient-specific guide members can be configured to mate inalignment with natural anatomic landmarks by orienting and placing thecorresponding alignment guide intra-operatively on top of the bone tomate with corresponding landmarks. The anatomic landmarks function aspassive fiducial identifiers or fiducial markers for positioning of thevarious alignment guide members, drill guides or other patient-specificinstruments.

The various patient-specific alignment guide members can be made of anybiocompatible material, including, polymer, ceramic, metal orcombinations thereof. The patient-specific alignment guide members canbe disposable and can be combined or used with reusable andnon-patient-specific cutting and guiding components.

More specifically, the present disclosure provides various embodimentsof patient-specific humeral cut guide members for anatomic and reversearthroplasty. The humeral cut guides of the present disclosure can havepatient-specific engagement surfaces that reference various portions ofthe shoulder joint and include tubular drill guides, guiding bores orsleeves or other guiding formations that can accurately position guidepins for later humeral preparation and implantation procedures and foralignment purposes, including implant position control, implant versioncontrol, implant inclination control for both anatomic and reversearthroplasty.

In the following, when a portion of a humeral guide member is describedas “referencing” a portion of the anatomy, it will be understood thatthe referencing portion of the humeral guide member is apatient-specific portion that mirrors or is a negative of thecorresponding referenced anatomic portion.

In some embodiments the humeral guide member can have built-in holes,openings or windows that allow the surgeon to mark the humeral bone or amodel of the humeral bone with a marking pen, burr, scalpel, or anyother device that can create markings to be used as landmarks on or inthe humeral bone or humeral model. These landmarks can be used for theorientation of a secondary guide.

Referring to FIGS. 1 and 2 , a prior art reverse shoulder implant 10 isillustrated. The reverse shoulder implant 10 includes a humeral stem 12,a humeral tray 14, a humeral bearing 16, a glenosphere 18 and abaseplate 20 having a plate portion 22 and a central boss 24. Thehumeral stem 12 is implanted in the humeral bone 26 and has a proximalend 28 coupled via a Morse taper connection to a male taper 30 extendingfrom a plate 32 of the humeral tray 14. The glenosphere 18 can bemodular and include a head 34 articulating with the bearing 16 and anoffset double-taper component 36. The double-taper component 36 has afirst tapered portion 38 coupled to a corresponding tapered opening 40of the head 34 and a second tapered portion 42 coupled to the centralboss 24 of the glenoid baseplate 20. A central screw 44 passes throughthe baseplate 20 into the glenoid face 46 of the patient's scapula.Peripheral screws 48 are used to lock the baseplate 20 in the glenoidface 46.

As best illustrated in FIG. 2 , humeral bone 26 includes a planarsurface 50 for abutment with plate 32 of humeral tray 14. To provideplanar surface 50, humeral bone 26 is cut using a tool such as a bonesaw (not shown). To properly orient the saw at the correct anglerelative to humeral bone 26, the present disclosure provides a humeralcut guide system 52.

Referring to FIGS. 3-5 , an exemplary humeral cut guide system 52according to an aspect of the present disclosure is illustrated. Humeralcut guide system 52 includes a patient-specific humeral cut guide member54. Humeral cut guide member 54 is configured to be patient-specificsuch that humeral cut guide member 54 mates with and nests in only oneposition on humeral bone 26. In this regard, humeral cut guide member 54includes a bone-engagement member 58 having a bone-engagement surface 60that is complementary and made to substantially mate and nest in onlyone position (i.e., as a substantially negative or mirror or inversesurface) with a three-dimensional bone surface 61 of humeral bone 26with or without associated soft tissues, which is reconstructed as a 3-Dimage via the aforementioned CAD or software.

As best illustrated in FIG. 3 , bone-engagement member 58 andbone-engagement surface 60 are each pie-shaped and specifically designedto mate and nest on a proximal portion of the lesser tuberosity 62 ofhumeral bone 26. An opposing surface 64 of bone-engagement member 58defines a protrusion 66 that provides a curved contact surface 68 thatallows humeral cut guide member 54 to be manipulated by the surgeon intocorrect alignment on the humeral bone 26. In other words, the surgeonmay place a finger-tip upon contact surface 68, which allows the surgeonto more easily orient the humeral cut guide member 54 in a manner thatbone-engagement surface 60 properly aligns with bone surface 62 ofhumeral bone 26.

A curved connecting member 70 extends away from bone-engagement member58 and connects bone-engagement member 58 with a patient-specific pinguide aperture 72. Pin guide aperture 72 is aligned per the specificpatient and allows for passage of a drill, Steinmann pin, or guidewire(not shown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26. As illustrated,connecting member 70 is spaced apart from humeral bone 26. It should beunderstood, however, that connecting member 70 may be designed to abuthumeral bone 26. In such a case, connecting member 70 may also include apatient-specific mating surface that is designed to mate and nest withhumeral bone 26 in a single position.

A registration member 74 extends away from bone-engagement member 58 ina direction different from that of connecting member 70. Similar tobone-engagement member 58, registration member 74 includes abone-engagement surface 76 that is designed to mate and nest withhumeral bone 26 in a single position. Specifically, bone-engagementsurface 76 of registration member 74 is patient-specifically sized andshaped to mate with the bicipital groove 78 (see, e.g., FIG. 6 ) ofhumeral bone 26. Thus, registration member 74 is an elongated tab-shapedmember having a proximal end 80 unitary or connected to bone-engagementmember 58 and a distal end 82 located away from bone-engagement member58. With the pie-shaped bone-engagement member 58 and elongatedregistration member 74, humeral cut guide member 54 is configured tonest with humeral head 26 in a single position with as little materialas possible. In this manner, a majority (i.e., at least 75%) of humeralhead 26 is exposed during the surgical procedure to allow the surgeongreater visual access to the humeral head 26.

Humeral cut guide member 54 includes a cut guide plate 84 including anelongated slot 86. As best shown in FIG. 5 , cut guide plate 84 isunitary or connected to bone-engagement member 58 with acylindrically-shaped member 88 that extends outward from bone-engagementmember 58 in a direction different from each of connecting member 70 andregistration member 74. Cylindrically-shaped member 88 extends outwardfrom bone-engagement member 88 to an extent that cut guide plate 84 willbe spaced apart from humeral head 26. By spacing cut guide plate 84 awayfrom humeral head 26, the unnecessary removal of soft-tissue (e.g.,muscle, cartilage, etc.) from humeral head 26 is prevented, whichassists in the patient's recovery after the arthroplasty. It should beunderstood, however, that cut guide plate 84 may be configured to abuthumeral bone 26 during pre-operative design of humeral cut guide system52, if desired.

Cut guide plate 84 includes an upper surface 90 and a lower surface 92,with elongated slot 86 positioned therebetween. Upper surface 90includes a reinforcing rib 94 extending along an entire length of uppersurface 90. Lower surface 92 defines a pair of tube-shaped apertures 96.Tube-shaped apertures are configured to receive a drill (not shown) fordrilling humeral bone 26. After drilling of the humeral bone 26, a pairof pins (not shown) such as Steinmann pins or K-wires may be implantedin humeral bone 26, which may be used to assist in securing humeral cutguide member 54 to humeral bone 26. Alternatively, the pair of pins maybe used to support a secondary cut guide (not shown) that is configuredto assist in resecting or resurfacing of the humeral bone 26 at adifferent angle in comparison to the angle defined by humeral cut guidemember 54. An exemplary secondary cut guide may be found in U.S. Ser.No. 14/265,577 assigned to Biomet Manufacturing, LLC. In this regard,after implantation of the pins, the humeral cut guide member 54 may beremoved from humeral bone 26 with the pins remaining in place. Thesecondary cut guide may then be mated with the pins relative to thehumeral bone 26.

Although not required, lower surface 92 may extend outward relative toupper surface 90 such that a shelf or platform 98 is formed. Platform 98allows for a greater amount of surface area for the tool blade (notshown) to lie upon during resurfacing or resecting of the humeral bone26. In this manner, the tool blade is substantially prevented from beingimproperly angled during the resurfacing or resecting of the humeralbone 26 to form planar surface 50. It should be understood that ifplatform 98 is used, upper surface 90 and reinforcing rib 94 may beomitted. In such a configuration, the tool blade would simply lie uponplatform 98 during resurfacing or resecting of the humeral bone 26.

Now referring to FIGS. 6-8 , another exemplary humeral cut guide system200 is illustrated. Humeral cut guide system 200 includes a humeral cutguide member 202. Humeral cut guide member 202 is configured to bepatient-specific such that humeral cut guide member 202 mates with andnests in only one position on humeral bone 26. In this regard, humeralcut guide member 202 includes a bone-engagement member 204 having abone-engagement surface 206 that is complementary and made tosubstantially mate and nest in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface 61 of humeral bone 26 with or withoutassociated soft tissues, which is reconstructed as a 3-D image via theaforementioned CAD or software.

As best illustrated in FIG. 6 , bone-engagement member 204 andbone-engagement surface 206 are specifically designed to mate and neston a distal portion of the lesser tuberosity 62 of humeral bone 26. Inthis regard, a bone-engagement member 204 is a curved member includingan upper edge 208 located adjacent the distal portion of the lesstuberosity 62, an opposing lower edge 210, and side edges 212.

As best illustrated in, for example, FIGS. 7 and 8 , bone-engagementmember 204 wraps about a portion of humeral bone 26 in the medialdirection from the bicipital groove 78. A registration member 214 islocated at a first end 216 of bone-engagement member 204. Registrationmember 214 extends away from upper edge 208 of bone-engagement member204 in a direction substantially orthogonal to bone-engagement member204. Similar to bone-engagement member 204, registration member 214includes a bone-engagement surface 218 that is designed to mate and nestwith humeral bone 26 in a single position.

Specifically, bone-engagement surface 218 of registration member 214 ispatient-specifically sized and shaped to mate with the bicipital groove78 of humeral bone 26. Thus, registration member 214 is an elongatedtab-shaped member having a proximal end 220 unitary or connected tobone-engagement member 214 and a distal end 222 located away from upperedge 208. With the bone-engagement member 204 and elongated registrationmember 214, humeral cut guide member 204 is configured to nest withhumeral head 26 at a position that allows for nearly an entirety (i.e.,at least 90%) of humeral head 26 to be exposed during the surgicalprocedure to allow the surgeon greater visual access to the humeral head26.

Humeral cut guide member 202 includes a cut guide plate 224 including anelongated slot 226. As best shown in FIG. 8 , cut guide plate 224 isunitary or connected to bone-engagement member 214 at a second end 228of bone-engagement member 214. Specifically, cut guide plate 224includes an upper surface 230 and a lower surface 232, with elongatedslot 226 positioned therebetween. Lower surface 232 defines a firsttube-shaped aperture 234 that, in addition to being configured toreceive a drill (not shown) for drilling humeral bone 26, connects cutguide plate 224 to second end 228. A second tube-shaped aperture 236 islocated at distal end 222 of registration member 214, and is connectedto cut guide plate 224 via a connecting arm 238.

Similar to the above-described embodiment illustrated in FIGS. 3-5 ,after drilling of the humeral bone 26, a pair of pins (not shown) suchas Steinmann pins or K-wires may be implanted in humeral bone 26 usingfirst and second tube-shaped apertures 234 and 236, which may be used toassist in securing humeral cut guide member 202 to humeral bone 26.Alternatively and as also described in the exemplary embodimentillustrated in FIGS. 3-5 , the pair of pins may be used to support asecondary cut guide (not shown) that is configured to assist inresecting or resurfacing of the humeral bone 26 at a different angle incomparison to the angle defined by humeral cut guide member 202.

Although cut guide plate 224 is illustrated as being spaced apart fromhumeral head 26, it should be understood that cut guide plate 224 may beconfigured to abut humeral bone 26 during pre-operative design ofhumeral cut guide system 52, if desired. By spacing cut guide plate 224away from humeral head 26, however, the unnecessary removal ofsoft-tissue (e.g., muscle, cartilage, etc.) from humeral head 26 isprevented, which assists in the patient's recovery after thearthroplasty. Further, although not required, lower surface 232 mayextend outward relative to upper surface 230 such that a shelf orplatform 98 (see FIG. 5 , described above) is formed. Platform 98 allowsfor a greater amount of surface area for the tool blade (not shown) tolie upon during resurfacing or resecting of the humeral bone 26. In thismanner, the tool blade is substantially prevented from being improperlyangled during the resurfacing or resecting of the humeral bone 26 toform planar surface 50.

Still further, it should be understood that humeral cut guide system 200may include the curved connecting member 70, which may extend away fromupper surface 230 of cut guide plate 224 and connect cut guide plate 224member with a patient-specific pin guide aperture 72 (see, e.g., FIG. 3). The pin guide aperture 72 may be aligned per the specific patient andallows for passage of a drill, Steinmann pin, or guidewire (not shown),that allows humeral bone 26 to be reamed at the appropriate location forany desired resurfacing of humeral bone 26.

Now referring to FIGS. 9 and 10 , another exemplary humeral cut guidesystem 300 is illustrated. Humeral cut guide system 300 includes ahumeral cut guide member 302. Humeral cut guide member 302 is configuredto be patient-specific such that humeral cut guide member 302 mates withand nests in only one position on humeral bone 26. In this regard,humeral cut guide member 302 includes a bone-engagement member 304having a bone-engagement surface 306 that is complementary and made tosubstantially mate and nest in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface 62 of humeral bone 26 with or withoutassociated soft tissues, which is reconstructed as a 3-D image via theaforementioned CAD or software.

As best illustrated in FIG. 9 , bone-engagement member 304 andbone-engagement surface 306 are specifically designed to mate and nestmedially off of the proximal humeral bone 26. In this regard, abone-engagement member 304 is a curved member including an upper edge308 located adjacent the distal portion of the greater tuberosity 63, anopposing lower edge 310, and side edges 312. Bone-engagement member 304wraps about a portion of humeral bone 26 laterally from the distalportion of the greater tuberosity 63 in a direction toward bicipitalgroove 78, and includes a first end 314 and a second end 316. Extendingfrom second end 316 is a cut guide plate 318 including an elongated slot320.

As best shown in FIG. 9 , cut guide plate 318 is unitary or connected tobone-engagement member 304 at a second end 316. Cut guide plate 318includes an upper surface 322 and a lower surface 324, with elongatedslot 320 positioned therebetween. Lower surface 322 defines a firsttube-shaped aperture 326 that is configured to receive a drill (notshown) for drilling humeral bone 26, and after drilling of the humeralbone 26, is configured to receive a pin (not shown) that is operable tosecure humeral cut guide member 302 to the humeral bone 26. A secondtube-shaped aperture 328 may also be formed at second end 316 that isconfigured to receive a drill (not shown) for drilling humeral bone 26,and after drilling of the humeral bone 26, is configured to receive apin (not shown) that is operable to secure humeral cut guide member 302to the humeral bone 26. The above-noted configuration allows for nearlyan entirety (i.e., at least 90%) of humeral head 26 to be exposed duringthe surgical procedure to allow the surgeon greater visual access to thehumeral head 26.

Although not illustrated, it should be understood that humeral cut guidesystem 300 may include the curved connecting member 70, which may extendaway from upper surface 322 of cut guide plate 318 and connect cut guideplate 318 with a patient-specific pin guide aperture 72 (see, e.g., FIG.3 ). The pin guide aperture 72 may be aligned per the specific patientand allows for passage of a drill, Steinmann pin, or guidewire (notshown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26. Alternatively,the curved connecting member 70 and pin guide aperture 72 may extendfrom upper edge 308 at a location positioned proximate first end 314.

In addition, although cut guide plate 318 is illustrated as being spacedapart from humeral head 26, it should be understood that cut guide plate318 may be configured to abut humeral bone 26 during pre-operativedesign of humeral cut guide system 300, if desired. By spacing cut guideplate 318 away from humeral head 26, the unnecessary removal ofsoft-tissue (e.g., muscle, cartilage, etc.) from humeral head 26 isprevented, which assists in the patient's recovery after thearthroplasty. Further, although not required, lower surface 322 mayextend outward relative to upper surface 320 such that a shelf orplatform 98 (see FIG. 5 , described above) is formed. Platform 98 allowsfor a greater amount of surface area for the tool blade (not shown) tolie upon during resurfacing or resecting of the humeral bone 26. In thismanner, the tool blade is substantially prevented from being improperlyangled during the resurfacing or resecting of the humeral bone 26 toform planar surface 50.

Now referring to FIGS. 11 and 12 , another exemplary humeral cut guidesystem 400 according to an aspect of the present disclosure isillustrated. Humeral cut guide system 400 includes a ring-shapedpatient-specific humeral cut guide member 402 that encircles the greatertuberosity 63 of the humeral head 26. Humeral cut guide member 402 ispatient-specific and includes a bone-engagement surface 404 that iscomplementary and made to substantially mate and nest in only oneposition (i.e., as a substantially negative or mirror or inversesurface) with a three-dimensional bone surface 61 of humeral bone 26with or without associated soft tissues, which is reconstructed as a 3-Dimage via the aforementioned CAD or software. Although humeral cut guidemember 402 is illustrated as being ring-shaped, it should be understoodthat humeral cut guide member 402 may be horseshoe-shaped (FIG. 13 ), ifdesired.

Humeral cut guide member 402, in addition to bone-engagement surface404, includes an upper surface 406 and a lower surface 408. Extendingradially inward and over humeral head 26 toward a center of humeral cutguide member 402 are a plurality of pie-shaped ribs 410. Ribs 410 mayinclude a wider proximal portion 412 unitary with humeral cut guidemember 402 and a narrower distal portion 414. Alternatively, ribs 410may include the same width along the entire length thereof. Althoughonly three ribs 410 are illustrated in FIGS. 11 and 12 , it should beunderstood that a greater or lesser number of ribs 410 may be used,without departing from the scope of the present disclosure. Regardless,spaces 411 between ribs 410 allow for easier viewing of humeral head 26by the surgeon during the surgical procedure. In this regard, humeralcut guide member 402 is designed such that at least 50% of the humeralhead 26 is exposed or visible when humeral cut guide member 402 is matedthereto.

The distal portions 414 terminate at a patient specific pin guideaperture 416. Pin guide aperture 416 may be aligned per the specificpatient and allows for passage of a drill, Steinmann pin, or guidewire(not shown), that allows humeral bone 26 to be reamed at the appropriatelocation for any desired resurfacing of humeral bone 26. Pin guideaperture 416 includes an exterior surface 418 and a bone-engagementsurface 420. Bone-engagement surface 420 may be patient specificallydesigned pre-operatively. Further, although ribs 410 are illustrated asbeing spaced apart from humeral head 26, it should be understood thatribs 410 may abut humeral head 26 with a patient specificbone-engagement surface as well.

A cut guide plate 422 is unitary or connected to humeral cut guidemember 402 by a pair of connection members 424 such that cut guide plate422 is spaced apart from humeral bone 26. By spacing cut guide plate 422away from humeral head 26, the unnecessary removal of soft-tissue (e.g.,muscle, cartilage, etc.) from humeral head 26 is prevented, whichassists in the patient's recovery after the arthroplasty. Cut guideplate 422 includes an upper surface 426 and a lower surface 428, with anelongated slot 430 positioned therebetween. Lower surface 428 defines apair of tube-shaped apertures 432 that are configured to receive a drill(not shown) for drilling humeral bone 26. After drilling of the humeralbone 26, the tube-shaped apertures 432 are configured to receive a pin(not shown) that is operable to secure humeral cut guide member 402 tothe humeral bone 26. The above-noted configuration allows for a majorityof humeral head 26 to be exposed during the surgical procedure to allowthe surgeon greater visual access to the humeral head 26.

Although cut guide plate 422 is illustrated as being spaced apart fromhumeral head 26, which is desirable to preserve soft tissue as notedabove, it should be understood that cut guide plate 422 may beconfigured abut humeral bone 26 during pre-operative design of humeralcut guide system 400, if desired. Further, although not required, lowersurface 428 may extend outward relative to upper surface 426 such that ashelf or platform 98 is formed. Platform 98 allows for a greater amountof surface area for the tool blade (not shown) to lie upon duringresurfacing or resecting of the humeral bone 26. In this manner, thetool blade is substantially prevented from being improperly angledduring the resurfacing or resecting of the humeral bone 26 to formplanar surface 50.

Moreover, although not illustrated in FIGS. 11 and 12 , it should beunderstood that humeral cut guide member 402 may include a registrationmember (see, e.g., the registration member 74 in FIG. 3 ) similar tothose described above. That is, humeral cut guide member 402 may includeregistration member (not shown) that extends away from humeral cut guidemember 402 in a direction different from that ribs 410 including abone-engagement surface 76 that is designed to mate and nest with thebicipital groove 78 of humeral bone 26.

Now referring to FIGS. 14-20 , another exemplary humeral cut guidesystem 500 according to an aspect of the present disclosure isillustrated. Humeral cut guide system 500 includes a patient-specifichumeral cut guide member 502. Humeral cut guide member 502 is configuredto be patient-specific such that humeral cut guide member 502 mates withand nests in only one position on humeral bone 26. In this regard,humeral cut guide member 502 includes a bone-engagement member 504having a bone-engagement surface 506 that is complementary and made tosubstantially mate and nest in only one position (i.e., as asubstantially negative or mirror or inverse surface) with athree-dimensional bone surface 62 of humeral bone 26 with or withoutassociated soft tissues, which is reconstructed as a 3-D image via theaforementioned CAD or software.

As best illustrated in FIG. 14 , bone-engagement member 504 includes anelongated primary member 508 extending in a first direction (i.e., adirection parallel with a coronal plane of the body) over humeral head26, including a pin guide aperture 510. Pin guide aperture 510 isaligned per the specific patient and allows for passage of a drill,Steinmann pin, or guide wire (not shown), that allows humeral bone 26 tobe reamed at the appropriate location for any desired resurfacing ofhumeral bone 26. Bone-engagement member 504 also includes a pair ofsecondary members 512 extending substantially orthogonal to primarymember 508. Secondary members 512 define a portion of bone-engagementsurface 506, and assist in mating and nesting humeral cut guide member502 in only one position on humeral bone 26 with or without associatedsoft tissues.

Bone-engagement member 504 also includes a registration member 514 thatis patient-specifically sized and shaped to mate with the bicipitalgroove 78 of humeral bone 26. Thus, registration member 514 is anelongated tab-shaped member having a proximal end 516 unitary orconnected to bone-engagement member 504 and a distal end 518 locatedaway from bone-engagement member 504. With the primary member 508,secondary members 512, and elongated registration member 514, humeralcut guide member 504 is configured to nest with humeral head 26 in asingle position with as little material as possible. In this manner, amajority of humeral head 26 is exposed during the surgical procedure toallow the surgeon greater visual access to the humeral head 26. In thisregard, humeral cut guide member 502 is designed such that at least 60%of the humeral head 26 is exposed or visible when humeral cut guidemember 402 is mated thereto.

Registration member 514 may also define a protrusion 520 that provides acurved contact surface 522 that allows humeral cut guide member 504 tobe manipulated by the surgeon into correct alignment on the humeral bone26. In other words, the surgeon may place a finger-tip upon contactsurface 522, which allows the surgeon to more easily orient the humeralcut guide member 504 in a manner that bone-engagement surface 506properly aligns with bone surface 62 of humeral bone 26.

Humeral cut guide member 502 includes a cut guide plate 524 including anelongated slot 526. As best shown in FIGS. 14, 15, 18, and 19 , cutguide plate 524 is connected to bone-engagement member 504 with atube-shaped member 528 that extends outward from registration member 514such that cut guide plate 524 may be spaced apart from humeral head 26.By spacing cut guide plate 524 away from humeral head 26, theunnecessary removal of soft-tissue (e.g., muscle, cartilage, etc.) fromhumeral head 26 is prevented, which assists in the patient's recoveryafter the arthroplasty. Although tube-shaped member 528 extends outwardfrom bone-engagement member 504 to an extent that cut guide plate 524will be spaced apart from humeral head 26, it should be understood,however, that the location of cut guide plate 524 may be adjusted alongtube-shaped member 528 such that cut guide plate 524 may be moved closerto humeral bone 26, if desired.

More specifically, cut guide plate 524 includes a connection portion 530at an end 532 thereof that is configured to mate with tube-shaped member528. Further, connection portion 530 may include a mating aperture 534that is designed to mate with one of a plurality of protrusions 536formed along a surface 539 of tube-shaped member 528. In this regard,connection portion 530 may be urged along tube-shaped member 528 toadjust the position of cut guide plate 524 relative to humeral head 26.As connection portion 530 is urged along tube-shaped member 528, themating aperture 534 will mate with protrusions 536 such that connectionportion 530 may be positioned at the selected protrusion 536. Connectionportion 530 may then only be moved when a force sufficient to disengagethe mating aperture 534 from the selected protrusion 536 is provided tothe connection portion 530. In this manner, the position of cut guideplate 524 may be selectively adjusted based on the preferences of thesurgeon during the shoulder arthroplasty. It should be understood thatalthough cut guide plate 524 has been described above as being movablealong tube-shaped member 528, the present disclosure contemplatesconfigurations where cut guide plate 524 is immovably fixed totube-shaped member 528.

As best shown in FIG. 16 , cut guide plate 524 includes an upper member538 spaced apart from a lower member 540, with elongated slot 526defined by a gap 542 between upper member 538 and lower member 540.Lower member 540 defines an elongated aperture 544 that is configured toreceive a drill (not shown) for drilling humeral bone 26. After drillingof the humeral bone 26, a pin (not shown) such as a Steinmann pin orK-wire may be implanted in humeral bone 26, which may be used to assistin positioning humeral cut guide member 502 relative to humeral bone 26.In the illustrated embodiment, elongated aperture 544 travels parallelto tube-shaped member 528 to allow cut guide plate 524 to move alongtube-shaped member 528 without interference from the pin (not shown). Ifcut guide plate 524 is immovable fixed to tube-shaped member 528,however, it will be appreciated that elongated aperture 544 may extendin a non-parallel manner relative to tube-shaped member 528 to assist insecuring cut guide member 502 to humeral bone 526.

Although only a single elongated aperture 544 is illustrated in thefigures, it should be understood that a pair of elongated apertures 544may be used to allow for a pair of pins to be used to support asecondary cut guide (not shown) that is configured to assist inresecting or resurfacing of the humeral bone 26 at a different angle incomparison to the angle defined by humeral cut guide member 502. Anexemplary secondary cut guide may be found in U.S. Ser. No. 14/265,577assigned to Biomet Manufacturing, LLC. In this regard, afterimplantation of the pins, the humeral cut guide member 502 may beremoved from humeral bone 26 with the pins remaining in place. Thesecondary cut guide may then be mated with the pins relative to thehumeral bone 26.

Although not required, lower member 540 may define a surface 546 thatextends outward relative to upper member 538 such that a shelf orplatform 548 is formed. Platform 548 allows for a greater amount ofsurface area for the tool blade (not shown) to lie upon duringresurfacing or resecting of the humeral bone 26. In this manner, thetool blade is substantially prevented from being improperly angledduring the resurfacing or resecting of the humeral bone 26 to formplanar surface 50.

Lastly, as best shown in FIG. 20 , a support bar 550 may fix uppermember 538 to lower member 540. Support bar 550 is formed at an oppositeend 552 of cut guide plate 524 relative to tube-shaped member 528, andassist in maintaining the proper gap 542 between upper member 538 andlower member 540. Notwithstanding, it should be understood that supportbar 550 is removable during surgery by cutting support bar 550 with thesaw or blade for resecting or resurfacing humeral bone 26, as desired bythe surgeon. It should be understood that although tube-shaped member528 is illustrated as fixing cut guide plate 524 in one positionrelative to humeral head 26, tube-shaped member 528 may be adjustable asillustrated in FIGS. 14-19 .

The foregoing description of the embodiments has been provided forpurposes of illustration and description. It is not intended to beexhaustive or to limit the disclosure. Individual elements or featuresof a particular embodiment are generally not limited to that particularembodiment, but, where applicable, are interchangeable and can be usedin a selected embodiment, even if not specifically shown or described.The same may also be varied in many ways. Such variations are not to beregarded as a departure from the disclosure, and all such modificationsare intended to be included within the scope of the disclosure.

What is claimed is:
 1. A humeral cut guide member for a humeral head fora specific patient, the humeral cut guide member comprising: a cut guidemember comprising: a body that is at least-partially ring-shaped todefine an interior region, the body comprising a patient-specific innersurface; wherein the patient-specific inner surface is shaped to atleast partially extend across a greater tuberosity of the humeral headfor the specific patient a patient-specific pin guide aperture disposedwithin the interior region, the patient-specific pin guide aperturebeing spaced from the body, wherein the patient-specific pin guideaperture defines a ring-shaped body having a bone-engaging surface; anda plurality of ribs connecting the patient-specific pin guide apertureand the body to define a plurality of spaces between the body andpatient-specific pin guide aperture, wherein ends of the ribs are spacedfrom the bone-engaging surface; and a cut guide plate attached to thebody.
 2. The humeral cut guide member of claim 1, wherein the ribs leaveat least 50% of the greater tuberosity exposed within the interiorregion.
 3. The humeral cut guide member of claim 1, wherein the ribs areconfigured to place the patient-specific pin guide aperture in apatient-specific location on the greater tuberosity.
 4. The humeral cutguide member of claim 1, wherein the ribs extend from a narrow end atthe patient-specific pin guide aperture to a wide end at the body. 5.The humeral cut guide member of claim 1, wherein the ribs are curvedsuch that the patient-specific pin guide aperture is spaced from thebody along an axis of the patient-specific pin guide.
 6. The humeral cutguide member of claim 1, wherein the body defines a full ring configuredto extend around the humeral head and across the greater tuberosity whenthe patient-specific pin guide aperture engaged the humeral head.
 7. Thehumeral cut guide member of claim 1, wherein the cut guide plate isattached to the body via a pair of connecting members.
 8. The humeralcut guide member of claim 1, wherein the cut guide plate comprises upperand lower surfaces that define a slot therebetween.
 9. The humeral cutguide member of claim 1, wherein the cut guide plate comprises a shelf.10. The humeral cut guide member of claim 1, wherein the cut guide platecomprises a tube-shaped aperture oriented toward the interior region.11. The humeral cut guide member of claim 1, further comprising aregistration member extending from the body in a direction opposite theribs, the registration member comprising a patient-specificbone-engaging surface.
 12. A humeral cut guide member for a humeralhead, the humeral cut guide member comprising: a ring-shaped body thatdefines an interior region, the ring-shaped body configured to extendaround the humeral head to encompass the greater tuberosity; a pin guidering disposed within the interior region; a plurality of arcuate ribsconnecting the pin guide ring and the ring-shaped body to define ahemi-spherical space; and a cut guide plate attached to the ring-shapedbody.
 13. The humeral cut guide member of claim 12, further comprising aregistration member extending from the ring-shaped body away from theinterior region, the registration member comprising a patient-specificbone-engaging surface.
 14. The humeral cut guide member of claim 12,wherein the ring-shaped body includes a gap so as to be non-continuous.15. The humeral cut guide member of claim 12, wherein the cut guideplate is attached to the ring-shaped body by a pair of connectionmembers.
 16. The humeral cut guide member of claim 12, wherein the cutguide plate is arranged to guide a cut of the humeral head in a planetransverse to a central axis of the pin guide ring.
 17. The humeral cutguide member of claim 12, wherein the ring-shaped body comprises apatient-specific inner surface and the ribs position the pin guide ringin a patient-specific location in the interior region spaced from thering-shaped body such that portions of the humeral head are visiblebetween the ribs.
 18. A humeral cut guide member for a humeral head fora specific patient, the humeral cut guide member comprising: a cut guidemember comprising: a body that is at least-partially ring-shaped todefine an interior region, the body comprising a patient-specific innersurface, wherein the patient-specific inner surface is shaped to atleast partially extend across a greater tuberosity of the humeral headfor the specific patient; a patient-specific pin guide aperture disposedwithin the interior region, the patient-specific pin guide aperturebeing spaced from the body; and a plurality of ribs connecting thepatient-specific pin guide aperture and the body to define a pluralityof spaces between the body and patient-specific pin guide aperture; anda cut guide plate attached to the body.
 19. The humeral cut guide memberof claim 18, wherein the body defines a fill ring configured to extendaround the humeral head and across the greater tuberosity when thepatient-specific pin guide aperture engaged the humeral head.